First Author: N.Muravleva RUSSIA
Co Author(s): I. Gorshkov N. Muravlyova P. Volodin
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The purpose is to evaluate the effectiveness of the microinvasive dosed intrascleral buckling technology in the treatment of local rhegmatogenous retinal detachment with the use of HealaFlow gel drainage implant.
Federal State Autonomous Institution S.N. Fyodorov Eye Microsurgery Cross-Sectoral Research and Technology Centre of the Healthcare Ministry of Russia. Russia, Moscow, Beskudnikovsky bul., 59a
The results of examination and surgical treatment of 8 eyes with recent local rhegmatogenous retinal detachment were analyzed. An average age of the patients was 41 years. The inclusion criteria were as follows: The best-corrected vision before the surgery not less than 0.7; the height of retinal detachment not more than 5mm and the length not more than 3 time clock-hours; one large or several small retinal breaks in the same line on the mid and the far periphery of the retina. The average axial length of an eye was 24.52±0.5mm; the average detachment height before the surgery was 3.58±0.5mm. The conjunctiva in the segment corresponding to the local retinal detachment was cut and separated, the lateral rectus muscles corresponding to the segment were selected, and a 3mm long sclerotomic cut was made in the retinal tear projection parallel to the sulcus on 2/3 depths of the sclera. The size of the formed intrascleral tunnel depended on the size of the retinal tear: HealaFlow gel drainage implant,was inserted into the intrascleral tunnel through a cannula. The entered drainage volume was 04-0.6ml. On the second day a transpupillary laser photocoagulation around the retinal tear was carried out with the following parameters: a power of 120-240mW, a laser spot diameter of 200-300μm, an exposure of 0.05
On the second day after the surgery, a control examination with the buckle height and length assessment was carried out. The buckle height and length were assessed by means of B-scan ultrasonography; the height was on average 4.2mm,and the length was 4.7mm. In three cases,the edges of tears were adapted, but residual subretinal fluid was present. Diuretics were prescribed to the patients, and a forced head posture was recommended. According to B-scan ultrasonography before the discharge, subretinal fluid was absent in all operated patients. An average best-corrected vision acuity after the surgery was 0.7. One month after the intrascleral buckling, a complete blocking of the break and adhesion of the retina to the choroid were observed in all cases; the residual buckle height depended on the initial data, but it was more than a half of the initial size. The control examination in 3 months showed that retina adhered in all cases,the tear was blocked, and the buckle was not detected. The analysis of the results of visometry and perimetry carried out 6 months after the surgical treatment of rhegmatogenous retinal detachment showed that there was no case of decrease in the average best-corrected vision acuity on this clinical material. Within 1 year of follow-up, there were no recurrence of the retinal detachment.
The proposed method of intrascleral buckling using HealaFlow gel drainage ensures high efficiency of surgical treatment of retinal detachment at a minimum injury rate, and can be recommended as an effective and low-invasive method for the treatment of uncomplicated local rhegmatogenous retinal detachment